DISCLAIMER Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this photo and/or video. If you don’t want your photo taken, please let us know. Thank you!
Please DO NOT disclose any Protected Health Information (PHI) PHI includes, but is not limited to: - Patient name - Date of birth - Address - Occupation - Name of patient’s friends/family - Other identifiable features, i.e. scars, tattoos, hair/eye color
Conflicts of Interest None – except a conflict with the virus
COVID-19 Update #18 Aug 20, 2020 CHARLES KRASNER M.D. UNR SCHOOL OF MEDICINE SIERRA NV VETERANS AFFAIRS HOSPITAL
Speakers Mark Pandori, Ph.D. Director, Nevada State Public Health Lab Faisal Siddiqui, M.D. Pulmonary/critical care specialist, Sierra NV VA Hospital Jessica Thompson, PharmD, BCPS (AQ-ID) Renown Health F. Kevin Murphy, M.D. Sierra Infectious Disease, Faculty UNSOM Sara Healy, M.D. Pediatric Infectious Disease, Renown Health Kim Jacques, PharmD, BCIDP Sierra NV VA Hospital
February 26- first COVID ECHO talk -53 cases/ 3 deaths in U.S.
August 18- six months later - 5, 5,481 481,795 795 cases 171, 171,799 799 deaths
New daily Nevada case numbers remain elevated with increased testing, but would expect a dec ecreas ease in daily positivity rate if simply due to greater availability of testing …
But we continue to have a marked increase in recent positivity rates suggesting we are missing many cases…
But fortunately, at least for now, we have ongoing decline in hospitalizations over last few weeks
And daily deaths remain elevated as Nevada passes the 1100 death mark this week
Case rate/1000 varies significantly by county
72-year-old male with hematuria needs elective cystoscopy to evaluate for possible bladder cancer Day before procedure a screening COVID RT-PCR test is positive Patient is informed, denies any symptoms typical of COVID Repeat PCR test performed 4 weeks later- still positive Covid-19 Case- RN calls patient, he has remained asymptomatic, RN a study in requests my input on case frustration Using CDC criteria, I cleared the patient as non-infectious and procedure rescheduled Day of procedure surgeon cancels it; states wants to delay procedure for another month
His Cepheid test results both the initial and one month later tests show very high Cycle threshold (Ct Ct) results JULY 15 RT-PCR TEST AUGUST 10 RT-PCR TEST
Percentage of positive Viral cell cultures as a function of Ct Ct (Cycle cle th thres eshold ld value) Remember – higher the Ct Ct, the lower the viral load- takes longer to reach the positive threshold value)
Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance- August 10,2020 update)
Newsweek reports: “those infected with COVID-19 are immune for just 3 months, CDC says”. However :
Duke University scientists tested 14 types of masks: what worked, what didn’t
Simple set-up developed to cou ount aerosolized drop oplets when speaking at normal volume with no mask on compared with wearing different HTTPS://WWW.YOUT types of face coverings UBE.COM/WATCH?V= LEEBN4TTZZY
The rundown on mask effectiveness – #1 the bes est t #2 the g good #1 N95 RESPIRATORS #2 SURGICAL MASKS The only mask type that best protects the Combine with a face shield or goggles for high wearer as well as others around them risk procedures. A shield should never be used to replace a mask.( Tied masks may be more effective than ear-looped ones- JAMA Int Med 8/11/2020)
#3 #3 the g goo ood d #4 the po he pointless ess COTTON/POLYESTER MASKS- BANDANAS 3 LAYER IN COMBINATION WITH DIFFERENT MATERIALS IS GOOD, BUT FIT IS MOST IMPOR TANT Little efficacy. The Mayo Clinic has recommended this an alternative to face masks
#6 … and t #5 Th The B Bad the Really Ba Bad NECK GAITERS VALVE MASKS- MADE OF FLEECE, WORSE THAN WEARING NO MASK, CREATED MORE PUTS OTHERS AT RISK, NOT INDICATED FOR PREVENTING LITTLE PARTICLES THAT LIKELY TRAVELED FARTHER THAN LARGER DROPLETS SPREAD OF INFECTION THAT FALL TO THE GROUND
Do not use N95 masks with valves!!! these masks protect the people wearing them but do not stop virus droplets from escaping and infecting others. May give false sense of security to people around them The masks are designed for construction workers or fire-fighters to use to keep out dust and other particles.
Quick and affordable saliva-based COVID-19 test developed by Yale scientists receives FDA Emergency Use Authorization- work financed by the NBA! No need for nucleic acid extraction kits, collection swabs or viral transport media. Patient collects their own sample. Non-profit, open source, can be done by various products already in use in most labs, cost about $1.50 to $4.00 to run. No proprietary equipment needed SalivaDirect:
Survey Please complete this brief survey. Your feedback is vital to our continued improvement of Project ECHO Nevada programming! Thank you!
Recommend
More recommend
